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Helen Hayes Hospital
Route 9W, West Haverstraw
NY 10993
Where Hope Has a Home, Helen Hayes Hospital Banner
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Patient Forms

The following forms are provided to help streamline the process for registering. Please print the forms for the department area that you will be receiving services and bring them with you on the day of your evaluation.

If you are receiving Tele-Therapy, the Consent for Tele-Therapy Services has been provided as a fillable PDF. Please download the form, fill it out on your computer, save and email the form back to Helen Hayes Hospital. For Tele-Therapy only, please email ACSSupervisors@helenhayeshosp.org. For all other services, please print at home, fill out and bring on the day of your evaluation.

 

Outpatient Therapy Forms: please print, fill out, and bring to your evaluation

 

Consent for Tele-therapy Services: please fill out and email to ACSSupervisors@helenhayeshosp.org

 

Bone Density: please print, fill out, and bring to your evaluation

 

Cardiac Rehabilitation: please print, fill out, and bring to your evaluation

 

Dental: please fill out and fax this form to 845-786-4881 or email ACSSupervisors@helenhayeshosp.org

 

Medical Doctors/Clinic: please print, fill out, and bring to your evaluation

 

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